Telepractice: A Practical and Effective Method

The issue

Until recently, the prevailing model for supporting deaf or hard of hearing (DHH) children  has been in-person services where practitioners and families are physically located at the same venue (e.g., home, clinic, or other community setting). In-person services have been regarded as the gold standard of service delivery, but many DHH children, especially those in rural areas, have difficulty accessing in-person services because of workforce shortages, extended waiting periods, and long distances. In 2020, the COVID-19 pandemic further reduced access for all families and highlighted the usefulness of telepractice. Telepractice uses real-time audio/video-conferencing technology to connect practitioners in one location with families in another. The use of telepractice accelerated rapidly during 2020 when mandatory lockdowns and physical distancing severely restricted the availability of in-person services.

In spite of current widespread use, many practitioners and families still express concerns about the effectiveness of telepractice and its viability as a permanent solution.

What we know

Telepractice is not a new method. As early as the 1960s, doctors used two-way radio and closed-circuit television to support patients remotely. Since then, technology has become more user-friendly, available, and affordable.  Telepractice has expanded during the last two decades into fields such as audiology and speech pathology. Despite its convenience, many practitioners and families were reluctant to use telepractice prior to COVID-19. Common reasons included lack of familiarity with the model and concerns about the quality and effectiveness of telepractice.

A growing body of research provides evidence that services delivered through telepractice are at least as effective as in-person services. Studies have investigated assessments and interventions in speech, language, and hearing, for children who are DHH, autistic, developmentally delayed, or have other disabilities. Overall, telepractice and in-person services achieved similar results.

One notable exception is that early intervention provided through telepractice may be more effective than in-person, particularly for DHH children. Telepractice supports practitioners’ use of family-centered practices and increases families’ engagement in early intervention, which contribute to positive child outcomes. Practitioners in telepractice tend to use more strategies to support and involve caregivers than practitioners in-person. Caregivers in telepractice participate more actively in sessions than caregivers in-person.

What we don’t know

The COVID-19 pandemic created an unprecedented need for practitioners to rapidly adopt telepractice. Many practitioners made the shift without specific training or support in implementing services through telepractice. The level of practitioner training may affect the quality of telepractice. More research is needed to understand how much and what type of training is required for practitioners to effectively implement services through telepractice.

We also need to understand how telepractice influences the way practitioners and families interact during sessions. Practitioners in telepractice coach caregivers to interact with their child more often than practitioners in-person, but we don’t know why. We also don’t know whether the practitioner acting as a coach affects the caregiver’s role or changes the way practitioners, caregivers, and children interact with each other during sessions. More research is needed to understand the potential influences of telepractice.

Finally, many governments made temporary modifications to regulations surrounding licensing, insurance, and privacy (e.g., HIPAA) to ensure access to telepractice during the pandemic. We don’t know if these changes will become permanent, but that may influence whether telepractice services will be offered in a post-pandemic world.

Implications

Evidence shows that telepractice can improve access to services, deliver services that are equivalent to (or better than) those provided in-person, and achieve positive outcomes for DHH children and their families. The recent surge in telepractice has increased familiarity with the model and will likely lead to greater acceptance and more positive attitudes towards its use. Telepractice certainly has a role to play in the future of service provision, but there is still work to be done.

During the COVID-19 pandemic, individuals, organizations, and governments reacted swiftly to incorporate telepractice. These radical changes kept us connected while remaining safely apart, but most were designed as temporary measures. As the urgency of the pandemic subsides, stakeholders can, and should, allocate time to review and improve these interim models so telepractice can remain a permanent option for families.

First, practitioners need to enhance their skills and evaluate their practices to ensure the quality of services provided through telepractice is equivalent to services provided in-person. Next, families need information and support to make informed decisions about telepractice, including how to identify quality services that match their needs. Finally, governments need to acknowledge the value of telepractice and revise the regulations restricting its use. Only then can we view telepractice as a permanent solution, rather than a temporary substitution.

Posted on April 20, 2021 by
Melissa McCarthy
The University of Newcastle
Australia
Melissa.Mccarthy{at}uon.edu.au

Further reading